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Dissertations / Theses on the topic 'Postoperative delirium'
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Fuller, Valerie J., and Valerie J. Fuller. "The Patient Experience of Postoperative Delirium." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/625719.
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Background: Postoperative delirium (POD) is a common neurocognitive disorder in patients undergoing surgical procedures. Delirium is a disorder that is poorly understood, frequently unrecognized and associated with numerous adverse outcomes including longer hospital stays, significantly higher costs and increased morbidity and mortality. While there has been a great deal of research on proposed etiologies, risk factors and outcomes of delirium, few studies have explored the patient’s subjective experience of the phenomenon.
Purpose: The purpose of this qualitative descriptive research was to investigate the patient experience of postoperative delirium and measure the distress associated with the experience. The Delirium Symptoms Experience Model (DSEM) provided the theoretical framework in which to understand the postoperative delirium experience. The three specific aims used to guide the investigation were: 1) Identify patient age, gender, race, type and length of surgery, past medical and surgical history, length of admission, delirium subtype (if known), and medications (including anesthetic agents) used in the perioperative period to better characterize the sample and provide context for the qualitative findings; 2) Describe the postoperative patients’ experience of being and feeling delirious; and, 3) Measure the distress associated with the recall of delirium using the Delirium Experience Questionnaire (DEQ)
Methods: Ten participants ranging in age from 33-75 years (mean = 66.2 years of age) who experienced postoperative delirium were interviewed. Patients were screened for persistent delirium or cognitive impairment as assessed with the Confusion Assessment Method and the Mini-Cog™ Instruments.
Results: Three organizing themes emerged from the content analysis: 1) Altered Perceptions of Reality; 2) Stuck in the Confusion; and, 3) Seeking Reality. The analysis of the quantitative measures and descriptive data demonstrated a high rate of psychological distress associated with delirium recall with 80% participants reporting it caused severe to very severe distress. The anesthetic drug propofol was the common medication prescribed in the perioperative period and given to all ten participants.
Conclusion: Understanding this phenomenon from the patients’ perspective may provide a better understanding of the delirium experience and aid in the development of interventions and treatments to improve care and reduce suffering.
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Snell, Jennifer Miranda. "Pediatric Emergence Delirium in the Postoperative Setting." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3921.
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Emergence delirium (ED), also known as emergence agitation, is a postoperative condition characterized by aberrant cognitive and psychomotor behaviors following general anesthesia. The incidence of ED is 3 to 8 times higher in children 5 years of age or less. There is no standard of nursing practice for managing ED symptoms in the pediatric surgical population. The purpose of this quality improvement project was to address a gap in knowledge needed to inform clinical decision-making when managing ED in the postoperative setting. Using an educational presentation for post anesthesia care unit (PACU) nurses, this project introduced the use of non-pharmacological interventions to mitigate symptoms of ED in the pediatric population as inspired by The Green Star Initiative, an Army program at Fort Carson. The project aim was to describe the effectiveness of ED-specific interventions from the nursing perspective. Using tenets of the Iowa model, this quality improvement project included a needs assessment survey, PowerPoint presentation, parent education leaflet, ED cheat sheet, and a post-intervention survey. Applying the context, input, process, product model for evaluation, this project increased knowledge of ED-specific interventions used by nurses that demonstrates a change in clinical decision-making. PACU nurses rated the interventions 43% effective on pediatric patients. This project addressed the gap in practice by providing structured education on ED, inspiring the use of ED-specific interventions, and promoting readiness to care for the pediatric surgical population. Outcomes add to the nursing literature by introducing ED-specific interventions to manage pediatric ED in facilities nationwide. A social implication of this project is to improve the care of pediatric surgical patients.
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Markström, Söder Erika, and Jon Melin. "Äldres erfarenheter av postoperativt delirium : en litteraturstudie." Thesis, Umeå universitet, Institutionen för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-178142.
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Bakgrund: Delirium är ett akut tillstånd som kan drabba olika individer. Tillståndet ärvanligt förekommande på intensivvårdsavdelningar och uppvaknings avdelningar ochpåverkar individens tankeverksamhet och koncentrationsförmåga vilket kan leda tillförvirring. Om tillståndet förekommer efter en operation benämns det som Postoperativtdelirium (POD). POD beskrivs som ett tillstånd som förlänger patientens sjukhusvistelseoch ökar dödligheten och drabbar främst äldre. Syfte: Att beskriva äldre patienters erfarenheter av postoperativt delirium. Metod: Denna litteratursammanställning baseras på nio kvalitativa studier. Studiernahittades i två databaser, Cinahl och Pubmed samt via manuella sökningar av referenslistor.Analysen genomfördes med Fribergs modell för analys av kvalitativa studier. Resultat: Genom analysen skapades tre huvudkategorier och nio subkategorier.Huvudkategorierna var: ‘Känslomässiga reaktioner’, ‘Kroppsliga obehag’ samt ‘Viktigtstöd’. Konklusion: Patienter behöver mer information gällande POD för att förstå sin situationbättre och kunna delta i sin egen vård. Vårdpersonal behöver mer utbildning för att förståpatientens behov under POD samt för att kunna förmedla kunskap om POD till anhöriga.En ökad kunskap kan även reducera kostnader för verksamheter där POD förekommer.Vidare forskning bör belysa hur patienter och verksamheten påverkas av att ge informationtill patienter angående POD.Background: Delirium is an acute condition that can affect different individuals. Thecondition is common in intensive care units and wake-up wards and affects the individual'sthinking activity and ability to concentrate witch leads to confusion. If the condition occursafter surgery, it is referred to as Postoperative Delirium (POD). POD is described as acondition that prolongs the patient's hospital stay and increases mortality and mainlyaffects the elderly. Aim: To describe elderly patients´experiences of postoperative delirium. Methods: This literature review is based on nine qualitative studies. The studies werefound in two databases, Cinahl, Pubmed and also via manual searches of reference lists.The analysis was performed with Friberg's model for analysis of qualitative studies. Results: The analysis created three main categories and nine subcategories. The maincategories were: ‘Emotional reactions’, ‘Physical discomfort’ and ‘Significant support’. Conclusion: Patients need more information regarding POD to better understand theirsituation and be able to participate in their own care. Nursing staff need more training tounderstand the patient's needs during POD and to be able to convey knowledge about PODto relatives. Increased knowledge can also reduce costs for operations where POD occurs.Further research should shed light on how patients and operations are affected byproviding information to patients regarding POD.
Pågrund av pågående pandemi hölls presentationen av examensarbetet via zoom möte.
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Lukas, Yani Stella <1976>. "Risk factors for postoperative delirium in the elderly." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2011. http://amsdottorato.unibo.it/3578/.
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Background: Delirium is defined as an acute disorder of attention and cognition. Delirium is common in hospitalized elderly patient and is associated with increased morbidity, length of stay and patient care costs. Although Delirium can develop at any time during hospitalization, it typically presents early in the post-operative period (Post-Operative Delirium, POD) in the surgery context. The molecular mechanism and possible genetics basis of POD onset are not known, as well as all the risk factors are not completely defined. Our hypothesis is that genetic risk factor involving the inflammatory response could have possible effects on the immunoneuroendocrine system. Moreover, our previous data (inflamm-aging) suggest that aging is associated with an increase of inflammatory status, favouring age-related diseases such as neurodegenerative diseases, frailty, depression among other. Some pro-inflammatory or anti-inflammatory cytokines, seem to play a crucial role in increasing the inflammatory status and in the communication and regulation of immunoneuroendocrine system.
Objective: this study evaluated the incidence of POD in elderly patients undergoing general surgery, clinical/physical and psychological risk factors of POD insurgency and investigated inflammatory and genetic risk factors. Moreover, this study evaluated the consequence of POD in terms of institutionalization, development of permanent cognitive dysfunction or dementia and mortality
Methods: patients aged over 65 admitted for surgery at the Urgency Unit of S.Orsola-Malpighi Hospital were eligible for this case–control study. Risk factors significantly associated with POD in univariate analysis were entered into multivariate analysis to establish those independently associated with POD. Preoperative plasma level of 9 inflammatory markers were measured in 42 control subjects and 43 subjects who developed POD. Functional polymorphisms of IL-1 α , IL-2, IL-6, IL-8, IL-10 and TNF-alpha cytokine genes were determined in 176 control subjects and 27 POD subjects.
Results: A total of 351 patients were enrolled in the study. The incidence of POD was 13•2 %. Independent variables associated with POD were: age, co-morbidity, preoperative cognitive impairment, glucose abnormalities. Median length of hospital stay was 21 days for patients with POD versus 8 days for control patients (P < 0•001). The hospital mortality rate was 19 and 8•4 % respectively (P = 0•021) and mortality rate after 1 year was also higher in POD (P= 0.0001). The baseline of IL-6 concentration was higher in POD patients than patients without POD, whereas IL-2 was lower in POD patients compared to patients without POD. In a multivariate analysis only IL-6 remained associated with POD. Moreover IL-6, IL-8 and IL-2 are associated with co-morbidity, intra-hospital mortality, compromised functional status and emergency admission. No significant differences in genotype distribution were found between POD subjects and controls for any SNP analyzed in this study.
Conclusion: In this study we found older age, comorbidity, cognitive impairment, glucose abnormalities and baseline of IL-6 as independent risk factors for the development of POD. IL-6 could be proposed as marker of a trait that is associated with an increased risk of delirium; i.e. raised premorbid IL-6 level predict for the development of delirium.
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Innervik, Sanna, and Helena Lewin. "Postoperativt Delirium : Intervention och prevention ur ett omvårdnadsperspektiv." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-398151.
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Postoperative delirium is a common complication that occurs in elderly patients undergoing surgery with anaesthesia. This condition causes feelings of fear, discomfort and suffering for the patient. The aim with this study was to describe what interventions that can be used to prevent or treat postoperative delirium and what effect they have on the condition. This study is a systematic review with a descriptive design which examines existing research on nursing interventions with the aim of preventing and treating postoperative delirium. The study is based on nine scientific original articles, seven were randomized controlled trials and two were quasi experimental studies. The literature search was made through Cinahl, psycINFO and PubMed. When all studies had been examined the results showed multiple interventions and most of them had a preventive or treating effect on postoperative delirium. The interventions focus on different ways to affect the condition. Some of them are geriatric consultation, music therapy and family as caregivers. Postoperative delirium can be both prevented and treated through different kinds of interventions. This study contributes to expanded knowledge on how the condition can be managed, however further research is needed to provide increased evidence and prove which interventions that can provide the most effective affect on postoperative delirium.Postoperativt delirium är en vanlig komplikation hos äldre som genomgått någon form av kirurgi under anestesi. Tillståndet innebär rädsla, obehag och lidande för patienten. Syftet med studien är att beskriva vilka omvårdnadsinterventioner som finns för att förebygga och behandla postoperativt delirium samt vilken effekt dessa har. Denna studie är en litteraturöversikt med beskrivande design som undersöker befintlig forskning kring omvårdnadsinterventioner med syfte att förebygga och behandla postoperativt delirium. Studien består av nio vetenskapliga originalartiklar, sju var randomiserade kontrollerade studier och två var kvasiexperimentella studier. Datainsamlingen genomfördes i databaserna Cinahl, psycINFO och PubMed. Efter att samtliga studier granskats framkommer ett resultat med flera olika omvårdnadsinterventioner där majoriteten har förebyggande eller behandlande effekt på postoperativt delirium. De interventioner som resultatet baseras på använder sig av olika sätt som tillståndet kan påverkas av. Några av dessa är geriatrisk konsultation, musikterapi och anhörig som vårdgivare. Postoperativt delirium kan förebyggas och behandlas på olika sätt via omvårdnadsinterventioner. Denna studie kan ge läsaren ökad kunskap om hur tillståndet kan hanteras, dock krävs det ytterligare forskning inom området för att ge ökad evidens och fastställa vilka typer av interventioner som har störst inverkan på postoperativt delirium.
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Cardholm, Ann-Christin. "Postoperativt delirium efter höftfraktur : Prevention och bemötande." Thesis, Stockholm University, Department of Education in Arts and Professions, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-8673.
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Akut förvirring hos höftfrakturpatienter är vanlig. Den akuta förvirringen kan förebyggas eller kortas och rehabiliteringstiden kan då också kortas. Ett förvirringstillstånd innebär stora påfrestningar på kroppen. Syftet med denna litteraturstudie är att se hur litteraturen beskriver hur man kan ge en god postoperativ omvårdnad och ett gott bemötande till de patienter som drabbas eller riskerar att drabbas av postoperativ förvirring. Till grund för arbetet ligger ett antal vetenskapliga artiklar samt facklitteratur. Trots att den postoperativa förvirringen är mycket vanlig, att den orsakar stort lidande och stora vårdkostnader, saknas tillfredsställande studier som kan ligga till grund för farmakologiska behandlingsrekommendationer. Oaktat detta ges ofta farmaka till dessa patienter. Enligt litteraturen har sjuksköterskans möte med den deliriösa patienten stor betydelse för att förebygga och lindra ett förvirringsbeteende. Eftersom det saknas riktlinjer för omvårdnad av akut förvirrade patienter beror det på den enskilda sjuksköterskans bemötande hur mötet med patienten blir. Den postoperativa förvirringen måste lyftas fram eftersom antalet patienter med höftfrakturer ständigt ökar. Rutiner och vårdprogram måste tas fram eller ses över. Vi måste lära oss att bemöta dessa patienter på ett professionellt sätt. Att möta den förvirrade höftledspatienten på ett etiskt och förberett sätt är en förutsättning för en bra vård.
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Lenoir, Lisette, and Heidi Pisto. "Övervakning, tidig upptäckt och omvårdnad av patienter med risk för postoperativ konfusion : En kvalitativ intervjustudie med sjuksköterskor på postoperativa avdelningar." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-323406.
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Bakgrund: Postoperativ förvirring är en vanligt förekommande komplikation på postoperativa vårdavdelningar. Ökad kunskap om postoperativ förvirring och hur tillståndet kan förebyggas, upptäckas och behandlas kan förkorta vårdtider, minska andra allvarliga postoperativa komplikationer samt minska kostnaderna för sjukvården. Syfte: Syftet var att undersöka vilka omvårdnadsstrategier och omvårdnadsåtgärder sjuksköterskor använder för att förebygga, upptäcka och behandla postoperativ förvirring och därmed minska onödigt lidande för patienterna på postoperativa avdelningar. Metod: Metoden var en kvalitativ intervjustudie med åtta sjuksköterskor på två postoperativa avdelningar på ett sjukhus i Mellansverige. En kvalitativ innehållsanalys användes för analysering av insamlade data. Resultat: Resultatet visade att sjuksköterskor hade olika omvårdnadsstrategier för omhändertagandet av patienter med risk för postoperativ förvirring samt med förvirrade patienter. Innehållsanalysen resulterade i sex kategorier; 1. Att se patienten, 2. Att förebygga, 3. Att upptäcka, 4. Att behandla, 5. Hinder för omvårdnad samt 6. Sjuksköterskans behov för att kunna ge omvårdnad. Slutsats: Resultatet visade att sjuksköterskor ansåg att tidigt upptäckt av postoperativ förvirring är viktigt eftersom förvirringen kan leda till vårdskador och andra komplikationer. En tydlig strategi för att screena riskpatienter och för att upptäcka och behandla förvirring saknades och inget bedömningsinstrument för att mäta graden av förvirring användes. Sjuksköterskor önskade mer resurser för att kunna upptäcka och behandla postoperativ förvirring samt att postoperativ förvirring fick större fokus på avdelningen.Background: Postoperative confusion is a common complication in postoperative care units. Increased knowledge of prevention, detection and treatment of postoperative can shorten hospitalization for these patients and reduce other serious postoperative complications and costs to healthcare. Purpose: The aim of this study was to investigate which nursing strategies and nursing measures nurses use to prevent, detect and treat postoperative confusion, and thereby reduce unnecessary suffering for patients in postoperative care unit. Method: The method used was a qualitative interview study including eight nurses at two postoperative care units at a hospital central Sweden. A qualitative content analysis was used for analysis of the collected data. Results: The results showed that nurses had different nursing strategies for the treatment of patients at risk for postoperative confusion and for confused patients. The content analysis resulted in six categories; 1. To see the patient , 2. To prevent, 3. To detect, 4. To treat, 5. Complications to nursing, and 6. Nurse’s needs to provide nursing. Conclusion: Nurses considered that early detection of postoperative confusion is important because confusion can lead to care injuries and other complications. A clear strategy for screening risk patients, detecting and treating of confusion was missing. No assessment tool was used för measuring the grade of confusion. Nurses wanted more resources to detect and treat postoperative confusion and more focus on postoperative confusion on care units.
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Ljung, Isabel, and Hanna Eriksson. "Patienters upplevelser av delirium i samband med vård på somatisk vårdavdelning : - en litteraturstudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-339289.
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Bakgrund: Delirium är ett vanligt förekommande tillstånd inom somatisk vård. År 2016 var 85 % av patienterna som diagnosticerades med delirium i Sverige 70 år eller äldre. Det finns många olika faktorer som bidrar till uppkomsten av delirium, bland annat hög ålder, hypertoni, att genomgå kirurgi, tidigare hjärtsjukdom eller stroke och kognitiva nedsättningar. Syfte: Syftet med studien var att undersöka patienters upplevelse av delirium. Metod: En litteraturstudie där resultatet grundas på tio kvalitativa originalartiklar med intervjustudie som metod. Artiklarna söktes i databaserna PubMED, CINAHL och PsycINFO. Resultat: Fyra huvudkategorier framkom vid granskning av resultatet; Upplevelser av en förändrad verklighet, Upplevelser av starka känslor, Upplevelser av att minnas tillbaka och Upplevelser av bemötande. Patienterna beskrev starka känslor av rädsla, oro och ilska i samband med delirium. Känslor av isolering och otrygghet förekom när patienternas verklighetsuppfattning var nedsatt. Rädsla kunde uttryckas genom aggressivitet vilket kan bidra till stigmatisering och försvårande omständigheter för patienten. Lugn, närvaro och säkerhet hos sjuksköterskan ingav patienterna trygghet. Att minnas tillbaka på delirium orsakade känslor av skam, skuld och ånger. Några förnekade att de haft delirium medan andra uppskattade att samtala om sina upplevelser. Sjuksköterskans kompetens hade stor betydelse för patienternas upplevelser av bemötande. Slutsats: Upplevelsen av delirium är individuell. Att bli bekräftad och sedd som en unik individ beskrevs av patienterna leda till ökat välbefinnande. Sjuksköterskan har en viktig roll i att informera och stötta patienten för att minska stigmatisering och lidande. Det är också betydelsefullt att sjuksköterskan behandlar patienternas upplevelser med respekt.Background: Delirium is a common condition within somatic care. In 2016 85 % of patients diagnosed with delirium in Sweden were 70 years of age or older. There are many different factors that contribute to the onset of delirium, including high age, hypertension, undergoing surgery, previous heart disease orr stroke and cognitive impairments. Aim: The aim of the study was to explore patients’ experiences of delirium. Method: A literature study where the result is based on ten qualitative original articles with interviews as a method. The articles were searched in the databases PubMED, CINAHL and PsycINFO. Results: Four main categories emerged when reviewing the results; Experiences of a Changed Reality, Experiences of Strong Emotions, Remains of Remembrance and Experiences of Personal Treatment. Patients described strong feelings of fear, concern and anger associated with delirium. Feelings of isolation and insecurity occurred when the patient's perception of reality was reduced. Fear could be expressed through aggressiveness, which could contribute to stigmatization and aggravating circumstances for the patient. The calm, presence and safety of the nurse provided patients with security. Recalling delirium caused feelings of shame, guilt and regret. Some denied that they had delirium while others appreciated talking about their experiences. Nursing skills were of great importance to the patient's experiences of treatment. Conclusion: The experience of delirium is individual. Becoming confirmed and seen as a unique individual was described by patients leading to increased well-being. The nurse has an important role in informing and supporting the patient to reduce stigmatization and suffering. It is also important that the nurse treats the patient's experiences with respect.
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Schneider, Moritz [Verfasser]. "Das frühe postoperative Delirium : Vergleich des Nursing Delirium Screening Scale und der Confusion Assessment Method / Moritz Schneider." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2009. http://d-nb.info/1027813674/34.
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Johansson, Felix, and Simon Thunberg. "Föräldrars betydelse i vården av barn med delirium som vårdas inom intensivvårdsmiljö." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-388845.
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Bakgrund: Delirium är en vanligt förekommande komplikation både i barnintensivvården och barnoperationsvården. Det orsakar stort lidande hos de påverkade barnen både emotionellt och fysiskt, samt ökar delirium vårdtiden och orsakar en ökad mortalitet. Syfte: Att presentera vilka omvårdnadsåtgärder som kan förebygga delirium hos barn samt undersöka vad som påverkar vårdrelationen mellan barnet, familjen och sjuksköterskan vid omvårdnad och behandling av delirium i en intensivvårdsmiljö. Metod: Litteraturstudie baserad på kvantitativa studier analyserad med innehållsanalys. Resultat: Analysen resulterade i tre teman: effekten av föräldrars involvering på barn med delirium, övriga effekter av föräldrars involvering i vården av barn och betydelsen för ökad involvering för föräldrarna. Ökad involvering av föräldrarna i den pre och postoperativa vården gav en signifikant förbättring av postoperativt delirium hos barnet, under förutsättning att föräldrarna fått utbildning och blivit förberedda hur de skulle agera. Den ökade involveringen av föräldrar sågs som positivt av både föräldrar och personal. Analysen resulterade inte i några specifika omvårdnadsåtgärder som kan förebygga delirium hos barn. Slutsats: Föräldrar bör få möjligheten att vara så nära sina barn som möjligt och vara involverade i vården på barnintensivvårdsavdelning eller i den pre- och postoperativa vården. För att minska risken att barn drabbas av delirium finns behov av att utbilda och förbereda föräldrarna.Background: Delirium is a common complication at both pediatric intensive care units and pediatric postoperative units and it is causing huge amount of increased suffering for the affected children. Not only the emotional and physical suffering, but also increased time needed to stay in the PICU and increased mortality. Aim: To examine which nursing actions can prevent emergence delirium in children and to examine the importance of the care relationship between the child, the family and the nurse in the care and treatment for delirium. Method: A literature review with a quantitative approach, analyzed with content analysis. Results: The analysis resulted in three themes. The effect of parental involvement on the delirium of children, other effects on the involvement of parents in the care of children and the meaning of the involvement for the parents. The involvement of parents in children pre and postoperative had a significant decrease of delirium and negative behavior under the condition that the parents were prepared and active in their role as a support for their children. The increase parental involvement was viewed as positive from both parents and nurses. Analysis did not find any nursing actions to prevent delirium for children Conclusion: Parents should be able to be as close and involved in the care for their children in a PICU or in the pre and postoperative care as it is possible, and the need to educate and prepare the parents in order to decrease the risk for the children to suffer from delirium.
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Tran, Michael. "Factors associated with postoperative delirium in the geriatric population : implications for nursing intervention." Honors in the Major Thesis, University of Central Florida, 2001. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/306.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Nursing
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Andersson, Anna, and Anna Hardin. "Riskfaktorer för postoperativt delirium efter hjärtkirurgi : En systematisk litteraturstudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-84913.
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Bakgrund: Att genomgå hjärtkirurgi kan rädda en patients liv men det kan även leda till en ökad risk att drabbas av en komplikation som postoperativt delirium. Delirium är inte ett sjukdomstillstånd utan ett tillstånd av mental förvirring som påverkar patientens uppmärksamhet, medvetenhet och kognitiva förmåga. Postoperativt delirium kan leda till många negativa konsekvenser vilket kan medföra lidande för patienten. Vården ska ha som mål att lindra patientens lidande genom att se till hela patienten i den vårdande relationen, det är det som är kärnan i vårdvetenskap. Forskning har visat att det är viktigt för patientens postoperativa återhämtning att tidigt kunna upptäcka och förebygga postoperativt delirium. Det har framkommit att intensivvårdssjuksköterskor behöver ha ökad förståelse och kunskap om ämnet för att kunna upptäcka och förebygga postoperativt delirium efter hjärtkirurgi. Syfte: Syftet med studien är att identifiera riskfaktorer som kan påverka utvecklingen av postoperativt delirium bland intensivvårdspatienter efter hjärtkirurgi. Metod: En systematisk litteraturstudie där kvantitativa artiklar har analyserats efter Bettany-Saltikov och McSherry (2016) analysmetod. Resultat: Analysen resulterade i fyra kategorier: Patientens bakgrund, Tiden i hjärt-lungmaskin, Längden av respiratorbehandling samt Komplikationer till följd av hjärtkirurgi som är riskfaktorer som visade sig påverka utvecklingen av postoperativt delirium. Slutsats: Den samlade kunskapen som föreliggande studie har givit kan ligga till grund för intensivvårdssjuksköterskor i vården av patienter med postoperativt delirium. Intensivvårdssjuksköterskor ska ha med sig i den vårdande relationen att patientens situation är komplex och att det de utsätts för kan bidra till ökat lidande för patienten. Mer forskning behövs kring riskfaktorer för postoperativt delirium och hur den mentala förvirringen påverkar patienten och dess anhöriga.Background: Heart surgery can save a patient's life but can also lead to an increased risk of suffering from a complication such as postoperative delirium. Delirium is not an illness but a state of mental confusion that affects the patient's attention, awareness and cognitive ability. Postoperative delirium can lead to many negative consequences which can cause patient suffering. Nursing care has aimed to alleviate a patient's suffering by seeing the entire patient in the caring relationship. This is the core in nursing science. Research has shown that it is important for the patient's postoperative recovery to be able to detect and prevent postoperative delirium in an early stage. It has appeared that intensive care nurses need more education and knowledge in this area in order to be able to detect and prevent postoperative delirium after heart surgery. Aim: The aim of the study is to identify risk factors that are associated with the development of postoperative delirium after heart surgery within patients in the intensive care unit. Method: A systematic literature review that analyzed quantitative articles according to a method of analysis by Bettany-Saltikov and McSherry (2016). Result: Four categories emerged from the analysis: Patients background, length of mechanical ventilation, Heart- and lung machine duration and Complications after heart surgery that were risk factors which affected the development of postoperative delirium. Conclusion: The overall knowledge that the study has provided can form a basis for intensive care nurses in the care of patients with postoperative delirium. Further research is needed on risk factors for postoperative delirium and how the mental confusion affects both the patient and relatives. More research is also needed about how postoperative delirium can be prevented.
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Böhme, Lina Juliane [Verfasser]. "Das postoperative Delir auf der peripheren chirurgischen Station : Validierung der Nursing Delirium Screening Scale und des Delirium Detection Score / Lina Juliane Böhme." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2014. http://d-nb.info/1052530222/34.
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Olsson, Sandra, and Katarina Stenvik. "Peroperativa riskfaktorer för utveckling av postoperativt delirium vid hjärtkirurgi : en litteraturstudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-93439.
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Bakgrund: Postoperativt delirium (POD) är en allvarlig komplikation till hjärtkirurgi och anestesi. Det är ett akut konfusionstillstånd som orsakar lidande för patienter och anhöriga. Det associeras med många negativa konsekvenser som förlängd sjukhusvistelse, ökad dödlighet och nedsatt kognitiv och funktionell återhämtning. POD kan påverka livskvaliteten senare i livet och det är av betydelse att tillståndet förebyggs, diagnosticeras och behandlas tidigt. Syfte: Syftet var att identifiera peroperativa riskfaktorer som kan påverka utvecklingen av POD hos patienter som genomgår hjärtkirurgi. Metod: En litteraturstudie med systematisk sökning med 14 inkluderade studier som redovisats i en narrativ sammanställning efter Bettany-Saltikov och McSherry (2016) analysmetod. Resultat: Analysen resulterade i sex teman: Patienters bakgrund och sjukhistoria, Patienters hemodynamik, Patienters behov av läkemedel, Patienter i mekanisk ventilation, Patienter i hjärt-lungmaskin och Patienters operationstid som kan påverka utveckling av POD vid hjärtkirurgi. Slutsats: Utvecklingen av POD är dålig förstådd trots många studier och det beror på att det är multifaktorellt. Föreliggande studie bekräftar detta då inga generella slutsatser kan dras utifrån studiens resultat. Det verkar vara av betydelse att upprätthålla en välbalanserad peroperativ anestesi i synnerhet då det handlar om äldre och multisjuka. Patienter upplever lidande vid POD och är i behov av trygghet, värdighet och säkerhet med helhetlig omvårdnad för patienter och anhöriga. Ytterligare forskning behövs i syfte att utarbeta riktlinjer för att förebygga POD och nå konsensus kring riskfaktorer för POD.Background: Postoperative delirium (POD) is a serious complication of cardiac surgery and anesthesia. It is an acute confusion condition that causes suffering for patients and relatives. It is associated with many negative consequences such as prolonged hospitalization, increased mortality and reduced cognitive and functional recovery. POD can affect the quality of life later in life and it is imperative that this condition is prevented, diagnosed and treated at an early stage. Preoperative risk factors are well studied, but preoperative risk factors for POD that anesthetic nurses could influence are less known. Purpose: The purpose of this systematic literature study was to identify preoperative risk factors that may affect the development of POD in patients undergoing cardiac surgery. Method: A literature study with systematic search including 14 studies reported in a narrative compilation following Bettany-Saltikov and McSherry (2016) method of analysis. Results: The analysis resulted in six themes: Patients background and medical history, Patients hemodynamics, Patients need for drugs, Patients duration on mechanical ventilation, Patients duration in cardiac pulmonary bypass (CPB) and Patients operation time that can influence the development of POD during cardiac surgery. Conclusion: The development of POD is poorly understood despite many studies and this is because it is multifactorial. The present study confirms this as no general conclusions can be drawn from the study's results. It seems to be important to maintain a well-balanced peroperative anesthesia, especially when it comes to the elderly and comorbidities. Patients experience suffering from POD and need support, dignity and security with comprehensive care for patients and their relatives. Further research is needed in order to develop guidelines to prevent POD and reach a consensus on risk factors for POD.
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Åslund, Adelina, and Johanna Rydén. "Åtgärder för att förebygga postoperativ konfusion på somatiska vårdavdelingar." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-432173.
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Bakgrund: Konfusion är ett akut förvirringstillstånd som är vanligt förekommande efter kirurgi där en desorientering av tid, rum, situation eller person sker vilket kan leda till längre vårdtider, ett ökat behov av rehabilitering samt en ökad dödlighet. Detta innebär dels ett lidande för patienten, men även en ökad belastning på vården med ökade kostnader på grund av den längre vårdtiden. Genom att förebygga postoperativ konfusion skulle de negativa konsekvenserna kunna förhindras och patientens lidande därmed minska. Syfte: Syftet med studien var att identifiera vilka icke-farmakologiska åtgärder som beskrivs i vetenskaplig litteratur för att förebygga postoperativ konfusion på somatiska vårdavdelningar. Metod: En deskriptiv litteraturstudie som baserats på tio kvantitativa originalartiklar publicerade år 2015–2020. Databaserna som användes var PubMed och Cinahl. Artiklarnas kvalitet granskades och de sammanställda artiklarnas resultat analyserades och resultatet delades in teman och kategorier för ge en bättre överblick inom området. Resultat: Som förebyggande åtgärder för postoperativ konfusion identifierades i det sammanvägda resultatet fem teman. Dessa var kunskap, orientering, miljö, basal omvårdnad och smärta. Inom temana identifierades även kategorier där kommunikation, utbildning av personal samt ett nära samarbete med närstående visades vara en viktig del i att förebygga postoperativ konfusion på somatiska vårdavdelningar. Slutsats: Med icke-farmakologiska förebyggande åtgärder riktade mot kunskap, orientering, miljö, basal omvårdnad och smärta kunde fler fall av postoperativ konfusion förebyggas. Genom detta kunde därmed även patientens lidande och belastningen på vården minskas.Background: Delirium is an acute state of confusion that is common post surgery where a disorientation of time, situation and person occurs which can lead to longer length of stay, an increased need for rehabilitation and an increased mortality. This leads to suffering for the patient but also an increased burden on healthcare. By preventing postoperative delirium the negative consequences could be avoided and the suffering of the patient thereby decrease. Aim: The aim of this study was to identify non-pharmacological measures that are described in scientific literature to prevent postoperative delirium in somatic wards. Methods: A descriptive literature study based on ten quantitative peer reviewed articles published between 2015–2020. The databases that were used were Pubmed and Cinahl. The compiled results were evaluated and the compiled results were analyzed and then categorized into themes to give a better overview of the field. Results: As preventive measures for postoperative delirium five themes were identified in the result. These were knowledge, orientation, environment, nursing care and pain. Within these themes categories were also identified and communication, staff education and a close cooperation with relatives were an important part in preventing postoperative delirium in somatic wards. Conclusion: With non-pharmacological preventive measures aimed towards knowledge, orientation, environment, nursing care and pain more cases of postoperative delirium could be prevented. These preventive measures could thereby decrease the patients suffering and the burden on healthcare.
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Kjorven, Mary Colleen. "An exploration of the discursive practices that shape and discipline nurses' response to postoperative delirium." Thesis, University of British Columbia, 2009. http://hdl.handle.net/2429/9591.
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Delirium is a common, costly, and dangerous condition, especially among older adults. Delirium is a medical emergency, which requires early recognition and immediate evaluation and treatment of the underlying cause(s) to prevent negative outcomes. Although delirium is classified as a medical emergency, it is often not treated as such by health care providers. Perhaps because of the prevailing myth that confusion is a normal change that occurs in aging adults, recognition and prognostic significance of delirium is often overlooked. Powerful discourses have served to construct delirium in such a way that it is approached as less important than other clinical phenomenon.
The aim of this study was to critically examine the language practices and discourses that shape and discipline nurses’ care of older adults with postoperative delirium (POD) with a purpose to question accepted nursing practice. By illuminating these great systems, good theories and vital truths and exploring the knowledge/power link through a poststructural, Foucauldian concept of discourse, it is possible to raise questions toward new possibilities of improvements in nursing care and patient outcomes.
The study was based on data collected from face-to-face, in-depth, personal interviews with six nurses (four Registered Nurses and two Licensed Practical Nurses) who work on an acute 37 bed surgical unit which provides postoperative care for orthopedic, urology and neurology patients. This unit is located in a 450-bed tertiary care hospital in Western Canada.
Interviews were conducted at a time and place that was convenient for the participants. Data was digitally recorded and transcribed by the researcher verbatim. Five analytic readings of the data identified two prominent discourses at work in nursing practice, which influenced the care of patients with POD. These were identified as discourses of legitimacy/illegitimacy and discourses of nursing work. Through the process of poststructural analysis it became evident that one overriding discourse served to direct, legitimize and govern all other discourses. This discourse remains the biomedical/scientific discourse.
The findings of this study have implications for nursing knowledge and practice, education, improved patient outcomes and length of hospital stay.
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Hansson, Malin, and Isabelle Wolnievik. "Att förebygga akut konfusion hos patienter som har genomgått kirurgi : - en kvantitativ litteraturstudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-409023.
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Bakgrund: Akut konfusion är ett vanligt tillstånd hos patienter som genomgått kirurgi och innebär att patientens kognitiva förmåga är nedsatt. Forskning visar att patienter som drabbas av akut konfusion efter ett kirurgiskt ingrepp har högre mortalitet och resulterar i ett lidande för patienten med allvarliga komplikationer. Syfte: Syftet med litteraturöversikten var att sammanfatta olika omvårdnadsinterventioner som förebygger akut konfusion hos patienter som genomgått kirurgi. Metod: Litteraturöversikt med deskriptiv design där resultatet grundar sig på 10 kvantitativa originalartiklar. Resultat: Resultatet visade att en användning av screeningverktyg, anpassning av omvårdnadsmiljön och en medverkan av närstående kunde förebygga utvecklingen av akut konfusion hos patienter som genomgått kirurgi. Slutsats: Effektiva screeningsverktyg och rätt omvårdnadsåtgärder i kombination med närståendes medverkan är avgörande preventionsfaktorer för akut konfusion hos patienter som genomgått kirurgi. Sjuksköterskan har en avgörande roll i det patientnära arbetet eftersom det är här som rätt åtgärder måste sättas in – på så vis kan akut konfusion förebyggas och minska lidandet för patienten. Tillståndet bör därför uppmärksammas och förebyggas med hjälp av sjuksköterskans kompetens och omvårdnad.Background: Delirium is one of the most common postoperative complications and results in impaired cognitive function for the patient. It has been established from research that delirious patients had a higher risk for mortality, pathophysiological consequences and negative postoperative outcomes which can cause distress for the patient. Intention: The aim of this study was to survey nursing interventions that prevent delirium for patients who underwent surgery. Method: Quantitative literature review with a descriptive design, where the result is based on ten quantitative original articles. Results: The results show that use of clinical assessment tools for nurses, adaptation of the nursing environment and involvement of family members helped to prevent the development of delirium. Conclusion: Proper nursing assessment tools, adaptation of the nursing environment and involvement of family members helped prevent delirium. Nurses play a vital role in the patientcentered care as it is here warning signs needs to be identified – knowledge of this subject should therefore be studied. This helps to improve the quality of the nursing care, prevents delirium and reduces unnecessary suffering for the patients.
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Hämmerl, Thomas. "Delir, postoperative kognitive Verschlechterung und Charles-Bonnet-Syndrom bei Patienten mit Kataraktoperationen Häufigkeiten und Risikofaktoren /." [S.l.] : [s.n.], 2004. http://deposit.ddb.de/cgi-bin/dokserv?idn=97392277X.
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Oliveira, Fatima Rosane de Almeida. "Incidência, fatores preditores e consequências do delirium no pós-operatório de cirurgia cardíaca em idosos." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-11092015-160812/.
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Delirium é um estado confusional agudo caracterizado por um distúrbio de consciência, alteração na cognição e curso flutuante ao longo do dia. É a complicação mais comum observada em idosos hospitalizados. É freqüente no pós-operatório de cirurgia cardíaca, e pode chegar a taxas tão altas quanto 73% em pacientes mais idosos. Pacientes com delirium apresentam maior risco de morte, demência e institucionalização, aumento do tempo de internação hospitalar e dos custos. Os objetivos deste estudo foram: 1) determinar a incidência do delirium no pós-operatório de cirurgia cardíaca em idosos; 2) identificar fatores predisponentes e precipitantes neste contexto; 3) avaliar a relação entre delirium e morbimortalidade por até 18 meses de seguimento. Este estudo foi observacional, prospectivo, tipo coorte, realizado no Hospital de Messejana no período de Setembro/2011 à Dezembro/2013. Foram estudados 173 pacientes com idade > 60 anos. Antes da cirurgia, os pacientes foram avaliados quanto à função cognitiva através do MEEM e TFV, e pelo CAM, para determinar a presença de delirium pré-operatório, motivo de exclusão do estudo. Foram registradas variáveis referentes aos dados demográficos, doenças prévias, medicações utilizadas, e calculado o risco de mortalidade cirúrgica para cada paciente através do EuroSCORE II. Resultados de exames pré-operatórios como ECG, ecodopplercardiograma, cateterismo cardíaco, Doppler de carótidas e exames laboratoriais também foram registrados. Durante a cirurgia, as variáveis avaliadas foram o tempo de CEC e clampeamento de aorta, duração da cirurgia e anestesia e uso de hemoderivados. Como variáveis pós-operatórias foram analisados o TIOT, tempo de permanência na UTI, presença de disfunção renal, hipoxemia. O delirium foi avaliado pelo CAM-ICU no pós-operatório. Para o desfecho composto foram registrados óbitos por todas as causas, infecções e IAM perioperatório identificados até a alta hospitalar ou 30 dias após a cirurgia. Os pacientes foram seguidos por um período de 12 a 18 meses e registrados eventos como óbitos, reinternações e demência, através de nova avaliação com MEEM e TFV. Após análise univariada foi realizada análise multivariada por regressão logística múltipla para identificar as variáveis independentes. A idade média dos pacientes foi 69,5 + 5,8. Cerca de 75,14% eram hipertensos e 39,88% eram diabéticos. A média do EuroSCORE II foi 4,06 + 3,86. Cerca de 30,06% eram analfabetos. A média do grau de escolaridade foi 3,05 + 3,08 anos. A incidência do delirium foi 34,1%. Em 70% dos casos, o delirium foi detectado nos dois primeiros dias após a cirurgia. Foram identificados o grau de escolaridade (OR = 0,81; IC 95% 0,71 - 0,92; p=0,002), HAS (OR = 2,73; IC 95% 1,16 - 6,40; p=0,021) e a presença de valvopatia mitral ( OR = 2,93; IC 95% 1,32 - 6,50; p=0,008) como fatores predisponentes independentes para delirium. Como fator precipitante independente foi identificado o tempo de internação na UTI com OR=1,18; IC 95% 1,07 - 1,30 e p=0,001. O delirium foi fator de risco independente para o desfecho composto com OR=2,35; IC 95% 1,20 - 4,58 e p=0,012, além do TIOT > 900 minutos (OR=2,50; IC 95% 1,30 - 4,80; p=0,006) após análise multivariada. Não houve relação entre delirium e óbito após alta hospitalar, demência ou taxa de reinternação durante o seguimentoDelirium is an acute and transient syndrome with features of inattention and global cognitive dysfunction over the time. Among elderly hospitalized patients is the most common complication. The postoperative cardiac surgery delirium occurs in 73% in older patients. Delirium patients, have prominent risk factors for dementia, institutionalization, death, hospital care and increased cost of healthcare. The aims of this study were: 1) to determine the incidence of postoperative cardiac delirium, focusing particularly on elderly individuals; 2) to identify the predisposing and precipitating factors of delirium; 3) evaluate the morbi-mortality associated with delirium in a follow up of eighteen months. A prospective observational cohort study (n=173) patients, aged >= 60 years, admitted at Heart and Lung Messejana\'s Hospital between September/2011 to December/2013. Before the surgery, the Mini-Mental Status Examination (MMSE) and Verbal Fluency Test (VFT) were administered to assess patient\'s cognitive functioning. The patients were screened for delirium using the Confusion Assessment Method (CAM). Patients were excluded preoperatively if they met criteria for delirium. Variables related to demographic data, previous diseases, medications were recorded and EuroSCORE II calculated the risk of surgical mortality for each patient. Results of preoperative tests, like ECG, echocardiography, cardiac catheterization, carotid Doppler ultrassound and laboratory tests were also recorded. During the surgery, variables were ECC (extracorporeal circulation) and aortic clamping time, duration of surgery and anesthesia, and blood products were also recorded. Postoperative variables analyzed were: the orotracheal intubation time (OIT), length of stay in the ICU, renal dysfunction and hypoxemia. The postoperative delirium was accessed by CAM-ICU. Mortality from any cause, infection and perioperative myocardial infarction, identified until hospital discharge or 30 days after surgery were predefined as the composite endpoint. During a follow up of 12 to 18 months, a new assessment using MMSE and VFT were held; events such as, deaths, readmissions and dementia were recorded. Multivariate analysis was performed by multiple logistic regressions to identify independent variables. Patients aged 69.5 ± 5.8. About 75.14% were hypertensive; 39.88% were diabetic. The mean EuroSCORE II was 4.06±3.86. About 30.06% were illiterate; an average 3.05 ± 3.08 years of school. In 70% of cases, delirium was detected at the first two days after surgery with an incidence of 34.1%. The degree of literacy (OR = 0,81; 95% CI 0,71 - 0,92; p=0,002), hypertension (OR = 2,73; 95% CI 1,16 - 6,40; p=0,021) and mitral valve disease (OR = 2,93; 95% CI 1,32 - 6,50; p=0,008) were independently associated with delirium. Longer ICU length of stay (OR=1,18; 95% CI 1,07 - 1,30; p=0,001) was also independently associated with delirium as a precipitation factor. Delirium was an independent risk factor for the composite outcome (OR = 2.35; 95% CI 1.20 - 4.58 and p = 0.012); OIT > 900 minutes (OR = 2.50; 95% CI 1.30 - 4.80; p = 0.006) after multivariate analysis. There was no relationship between delirium and mortality after hospital discharge, as well as, dementia or hospital readmission during follow up
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Ha, Albert Sangji. "A Contemporary, Population-Based Analysis of the Incidence, Cost, Outcomes, and Preoperative Risk Prediction of Postoperative Delirium Following Major Urologic Cancer Surgeries." Thesis, Harvard University, 2017. http://nrs.harvard.edu/urn-3:HUL.InstRepos:32676128.
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Introduction
Postoperative delirium is associated with poor outcomes and increased healthcare costs across numerous surgical and medical disciplines. Although characterized in other surgical fields, the population-based incidence, outcomes, and cost of delirium have not been assessed in major urologic cancer surgeries. We sought to evaluate the incidence, outcomes, and cost of postoperative delirium after major urologic cancer surgeries, specifically after radical prostatectomy (RP), radical nephrectomy (RN), partial nephrectomy (PN), and radical cystectomy (RC) in the USA. We have also developed a preoperative risk prediction model specific to major urologic cancer surgeries to identify patients at high risk for postoperative delirium.
Methods
Using the Premier Hospital Database, we retrospectively identified patients who underwent radical prostatectomy (RP), radical nephrectomy (RN), partial nephrectomy (PN), and radical cystectomy (RC) from 2003 to 2013. Postoperative delirium was identified using ICD-9 codes, as well as postoperative use of antipsychotics, sitters, and restraints. We constructed regression models to assess for mortality, discharge disposition, length of stay (LOS), and direct hospital costs.
A preoperative risk stratification scoring system was also developed using known risk factors of delirium. The entire cohort was randomly divided into training (70%) and validation (30%) cohorts. Preoperative patient, hospital, and surgical characteristics associated with delirium were analyzed using multivariate regression, and a risk prediction score was developed using the training cohort. Its performance was quantified using Receiver Operating Characteristic (ROC) analysis in both cohorts.
Results
We identified 165,387 patients representing a weighted total of 1,097,355 patients. 30,063 (2.7%) experienced postoperative delirium. The greatest incidence of delirium occurred after RC, with 6,268 cases (11%). Delirious patients had greater adjusted odds of in-hospital mortality (OR 3.65; p <0.001), 90-day mortality (OR 1.47; p = 0.013), discharge with home health services (OR 2.25; p <0.001), discharge to skilled nursing facilities (OR 4.64; p <0.001), and 0.9-day increase in median LOS (p <0.001). Delirious patients also experienced a $2,697 increase in direct admission costs (p <0.001), with the greatest costs in RC patients ($30,859 vs. $26,607; p<0.001). The largest driver of costs was in room and board across all surgeries (p<0.001).
Our training and validation cohorts consisted of a weighted total of 767,408 and 329,926 patients, respectively. Our final model revealed many factors that increase risk for delirium, which were used to create a preoperative risk score. The additive score was predictive of delirium in both the training (OR: 1.35, 95% CI, 1.32-1.37, p<0.001) and validation cohorts (OR: 1.34, 95% CI 1.31-1.36, p<0.001). The score also demonstrated good discrimination in predicting delirium in the training (AUC: 0.74, 95% CI, 0.74-0.76) and validation (AUC: 0.75, 95% CI, 0.73-0.76) cohorts.
Conclusion
Patients with postoperative delirium experienced worse outcomes, prolonged LOS, and increased admission costs following major urologic cancer surgeries. In particular, the largest incidence and costs occurred in delirious patients after RC. Moreover, the results of the pre-operative risk prediction tool for delirium following major urologic cancer surgeries are promising given their consistency with published delirium risk factors and ease of use. Further testing will shed light on its clinical utility.
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Hamann, Johannes. "Postoperative Delirien und postoperative kognitive Defizite nach urologischen Eingriffen." [S.l.] : [s.n.], 2001. http://deposit.ddb.de/cgi-bin/dokserv?idn=963847120.
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Lindgren, Andreas, and Simonsson Rikard. "Omvårdnad i samband med postoperativt delirium : -En litteraturstudie." Thesis, Karlstads universitet, Institutionen för hälsovetenskaper, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-32097.
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Hos äldre som vårdas på sjukhus efter en operation är delirium en vanlig komplikation. Tidigare studier visar att postoperativt delirium resulterar i förlängd sjukhusvistelse och ökad mortalitet. Syftet med studien var att beskriva omvårdnad i samband med postoperativt delirium. Metoden var en litteraturstudie byggd på 17 artiklar ur databaserna CINAHL och Medline. Studien genomfördes enligt en modifierad version av Polit och Becks (2012) modell för litteraturstudier. Utifrån detta framkom ett resultat med tre huvudteman varav ett delades upp i underkategorier. De huvudteman som framkom var screening för att upptäcka riskfaktorer, åtgärder vidtas vid underliggande problem och konsultation med geriatrisk specialist. Resultatet redovisar även interventionsprogram som bygger på omvårdnadsåtgärder från ovan nämnda teman. Slutsatsen beskriver att postoperativt delirium har en mängd bakomliggande orsaker och omvårdnaden bör inriktas på att behandla alla dessa orsaker då åtgärder mot enskilda problem sällan löser det deliriska tillståndet.
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Holm, Josefine. "Att minska postoperativt delirium hos äldre En integrativ litteraturstudie." Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-84191.
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Seeling, Matthes [Verfasser]. "Validierung der Nursing Delirium Scale und der Delirium Detection Scale zur Detektion des frühen postoperativen Delirs / Matthes Seeling." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2009. http://d-nb.info/1023400863/34.
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Johansson, Pernilla, and Andersson Elin. "Intensivvårdssjuksköterskors erfarenheter av att vårda patienter med postoperativt delirium efter hjärtkirurgi." Thesis, Umeå universitet, Institutionen för omvårdnad, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-86945.
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ABSTRACT Aim. To describe intensive care nurses´ experiences of caring for patients with postoperative delirium after heart surgery. Background. Delirium is a common condition after heart surgery. Previous research has focused more on pathophysiology, incidence, etiology, prevention, detection and management, and less on how nurses caring for patients with delirium experience it. Design. A qualitative interview study. Method. Six intensive care nurses in a cardiothoracic intensive care unit were interviewed using a semi structured interview guide. Interviews where analyzed using qualitative content analysis. Results. The analyzed data resulted in a theme: desire to give good caring to patients with delirium, and three main categories: detecting delirium, caring for patients with delirium, willingness to improve care of patients with delirium. These main categories consisted of nine subcategories. Conclusion. Intensive care nurses´ goal is to provide good care even though the patient category is demanding. Despite increased awareness and transparency in the field of delirium care, it is important to highlight and address the emotions that arise as well as continuing with educational support to improve caring. Relevance to clinical practice. The intensive care nurse plays a key role in detecting, attending to and preventing postoperative delirium during patient care. The study highlights and confirms delirium as a challenge for nurses. The result can be used to raise awareness of the difficulties involved in nursing and highlight the need for improved knowledge and education in this area in order to improve nursing work environments.ABSTRAKT Syfte. Beskriva intensivvårdssjuksköterskors erfarenheter av att vårda patienter med postoperativt delirium efter hjärtkirurgi. Bakgrund. Delirium är ett vanligt förekommande tillstånd efter hjärtkirurgi. Tidigare forskning har fokuserat mer på patofysiologi, incidens, etiologi, sätt att förebygga, upptäcka och behandla, men mindre på sjuksköterskors upplevelser av att vårda patienter med delirium. Design. En kvalitativ intervjustudie. Metod. Sex intensivvårdssjuksköterskor på en thoraxkirurgisk intensivvårdsavdelning intervjuades efter en semistrukturerad intervjuguide. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat. Det analyserade materialet resulterade i ett tema: strävan efter en god omvårdnad för patienter med delirium, och tre huvudkategorier: att upptäcka delirium, att vårda patienter med delirium, att vilja förbättra för patienter med delirium. Dessa huvudkategorier bestod i sin tur av nio underkategorier. Konklusion. Intensivvårdssjuksköterskor strävar efter att ge en god omvårdnad även om det är en svår patientkategori att vårda. Det är viktigt att synliggöra de känslor som omvårdanden väcker och trots att medvetenheten ökat och problemen synliggjorts så finns fortfarande ett behov och en önskan om mer utbildning för att förbättra omvårdnaden. Klinisk betydelse. Intensivvårdssjuksköterskor spelar en viktig roll i att upptäcka, vårda och förebygga postoperativt delirium och är den som arbetar närmast patienten. Studien belyser och bekräftar att patienter med delirium är en utmaning för sjuksköterskor. Resultatet kan användas för att medvetandegöra de svårigheter som finns i omvårdnaden och synliggör behovet av mer utbildning och kunskap med syfte att förbättra sjuksköterskornas arbetssituation.
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Ribeiro, Juliana Caldas. "Avaliação da hemodinâmica encefálica em pacientes de alto risco submetidos a cirurgia cardíaca: papel do balão de contrapulsação intra-aórtico." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-06042017-085222/.
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Introdução: A cirurgia cardíaca resulta em taxa considerável de complicações neurológicas, incluindo delirium, disfunção cognitiva e acidente vascular cerebral isquêmico. Supõe que a fisiopatologia envolva embolia, aterotrombose, hipofluxo, redução do débito cardíaco e alterações da autorregulação cerebral. O balão de contrapulsação intra-aórtico (BIA) é um dispositivo de assistência circulatória comumente utilizado no perioperatório de pacientes de alto risco com o objetivo de otimização do débito cardíaco e da perfusão coronária. Apesar do benefício hemodinâmico do BIA, não é conhecido seu efeito na hemodinâmica encefálica. Objetivo: Avaliar os efeitos do BIA na hemodinâmica encefálica em pacientes de alto risco submetido a cirurgia cardíaca com circulação extracorpórea (CEC). Métodos: Trata-se de um subestudo do estudo clínico prospectivo e randomizado \"Balão de contra-pulsação intra-aórtico eletivo em pacientes de alto risco submetidos a cirurgia cardíaca\", realizado no Instituto do coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 2014 e 2016. Dos 181 pacientes incluídos no estudo randomizado, 67 pacientes foram incluídos no subestudo. Os pacientes eram adultos, submetidos a cirurgia cardíaca de revascularização miocárdica (RM) com fração de ejeção menor ou igual a 40% e/ou EuroScore maior ou igual a 6. Os mesmos foram randomizados para uso do BIA logo após a indução anestésica ou para grupo controle. A velocidade de fluxo sanguíneo cerebral (VFSC) pelo ultrassom Doppler transcraniano e a pressão arterial (PA) pelo Finometer foram continuamente gravados por 5 minutos antes da cirurgia (T1), 24h após (T2) e 7 dias após (T3). O índice de autorregulação (ARI) foi estimado através da resposta ao degrau da VFSC a mudanças na PA, derivados da análise da função de transferência. As seguintes complicações clínicas neurológicas foram avaliadas: delirium, disfunção cognitiva e acidente vascular cerebral isquêmico. Resultados: Dos pacientes incluídos no estudo, 34 foram alocados para a estratégia de uso profilático do balão intra-aórtico e 33 para a estratégia controle. Não houve diferenças significativas entre os grupos BIA e controle respectivamente, nos três tempos de avaliação, em relação ao ARI (T1 - 5,5 ± 1,9 vs 5,7 ± 1,7; T2 - 4,0 ± 1,9 vs 4,1 ± 1,6; T3 - 5,7 ± 2,0 vs 5,7 ± 1,6, P= 0,978) e em relação à VFSC (T1 - 57,3 ± 19,4 vs 59,3 ± 11,8; T2 - 74,0 ± 21,6 vs 74,7 ± 17,5; T3 - 71,1 ± 21,3 vs 68,1 ± 15,1; P=0,952). O grupo BIA e o grupo controle apresentaram incidência semelhante de complicações neurológicas (delirium na unidade de terapia intensiva - 26,5% vs 24,2%, P=0,834, acidente vascular cerebral isquêmico - 3,0% vs 2,9%, P=1,00, e declínio cognitivo pós-operatório através das escalas Mini Mental State Examination MMSE - 16,7% vs 40,7%; P= 0,073 e Avaliação Cognitiva Montreal MoCA - 79,16% vs 81,5%; P= 1,000). Conclusões: O uso profilático do BIA em pacientes de alto risco submetidos à cirurgia de revascularização do miocárdio não altera a hemodinâmica encefálica e não está associado ao aumento de complicações neurológicas como delirium, declínio cognitivo e acidente vascular cerebral isquêmicoIntroduction: Cardiac surgery is associated with a high incidence of neurologic complications, such as delirium, cognitive decline and stroke. The pathophysiology probably involves embolism, thrombosis, decreased cardiac output and abnormalities in cerebral autoregulation. The intraaortic balloon pump (IABP) is an assist device commonly in high-risk patients undergoing cardiac surgery aiming to increase the cardiac output and to improve the coronary perfusion. However, the effect of the IABP on the cerebral hemodynamic is unknown. Objectives: To assess the effect of IABP on cerebral hemodynamics in high-risk patients undergoing cardiac surgery with cardio-pulmonary bypass (CPB). Methods: This is a substudy of the randomized controlled trial \"Intraaortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery (IABCS trial)\", performed at the Heart Institute/University of Sao Paulo, from 2014 to 2016. Of the 181 patients included in the IABCS, 67 were included if they were submitted to cardiac surgery and if they had one of these two criteria: left ventricular ejection fraction equal or lower than 40% and/or EuroSCORE equal or higher than 6. Patients were allocated to the strategy of prohylatic IABP after anesthesia induction or to control. Cerebral blood flow velocity (CBFV) through transcranial Doppler and blood pressure (BP) through Finometer or intra-arterial line were continuously recorded over 5 minutes preoperatively (T1), after 24h (T2) and 7 days after surgery (T3). Autoregulation index (ARI) was estimated from the CBFV response to a step change in BP derived by transfer function analysis. The following complications neurologic were evaluated: delirium, cognitive decline and stroke. Results: Of the included patients, 34 were allocated to the IABP group and 33 to control group. There were no significant differences between the IABP and the control respectively in the following parameters: ARI (T1 - 5.5 ± 1.9 vs 5.7 ± 1.7; T2 - 4.0 ± 1.9 vs 4.1 ± 1.6; T3 - 5.7 ± 2.0 vs 5.7 ± 1.6, P= 0.978), CBFV (T1 - 57.3 ± 19.4 vs 59.3 ± 11.8; T2 - 74.0 ± 21.6 vs 74.7 ± 17.5; T3 - 71.1 ± 21.3 vs 68.1 ± 15.1; P=0.952). Both groups (IABP and control) had similar incidence of neurological complications (delirium - 26.5% vs 24.2%, P=0.834, stroke - 3.0% vs 2.9%, P=1.00, and cognitive decline through the scales Mini Mental State Examination MMSE - 16,7% vs 40,7%; P= 0.073 and Montreal Cognitive Assessment MoCA - 79.16% vs 81.5%; P= 1.000). Conclusions: The prophylactic use of IABP in high-risk patients undergoing cardiac surgery does not change the cerebral hemodynamic and is not associated with higher incidence of neurologic complications such as delirium, cognitive decline and stroke
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Johansson, Ingrid, and Erik Johnsson. "Postoperativ agitation och delirium hos barn efter generell anestesi Interventioner som minskar respektive ökar förekomsten." Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-74922.
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Bergmann, Katrin [Verfasser], Wilhelm [Akademischer Betreuer] Sandmann, and Jürgen [Akademischer Betreuer] Zielasek. "Postoperative Delirien nach gefäßchirurgischen Eingriffen unter Interventionsmaßnahmen / Katrin Bergmann. Gutachter: Wilhelm Sandmann ; Jürgen Zielasek." Düsseldorf : Universitäts- und Landesbibliothek der Heinrich-Heine-Universität Düsseldorf, 2011. http://d-nb.info/1015363504/34.
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Gernhardt, Christian-Felix [Verfasser]. "Risikofaktoren des postoperativen Deliriums in der Herzchirurgie : Eine prospektive Longitudinalstudie an 241 Patienten / Christian-Felix Gernhardt." Lübeck : Zentrale Hochschulbibliothek Lübeck, 2018. http://d-nb.info/1153844389/34.
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Waström, Moa Elisabet [Verfasser]. "Einfluss von Dauer und Schweregrad eines postoperativen Deliriums auf die Mortalität betroffener Patienten / Moa Elisabet Waström." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2015. http://d-nb.info/1071088602/34.
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Simões, Pedro Miguel Fernandes. "Postoperative delirium after curative surgery for cancer." Dissertação, 2018. https://hdl.handle.net/10216/112364.
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Simões, Pedro Miguel Fernandes. "Postoperative delirium after curative surgery for cancer." Master's thesis, 2018. https://hdl.handle.net/10216/112364.
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Chen, Yu-Shang, and 陳右尚. "Risk Factors of Postoperative Delirium in Elderly Patients with Hip Fracture." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/tvu8n2.
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碩士國立臺灣大學
護理學研究所
106
Background: Orthopedic surgery is the best treatment recommended for hip fractures, however, the procedure often induce postoperative delirium. Any age group is susceptible to postoperative delirium, but high prevalence rates of post-operative delirium have been found in geriatric patients with hip fracture. Purpose: There is a lack of research focused on the geriatric population with hip fracture. The purpose of this study was to establish the incidence rate of post-operative delirium among elderly patients and to identify risk factors. Methods: A prospective observational design with repeated measures was used. Subjects older than 65 years who had suffer from hip fracture due to fall will be recruited when admitted in orthopedic ward. The Confusion Assessment Method will be the study tool to assess twice a day to identify subjects experiencing delirium by research team. The demographic data, history of illness, operation process, and laboratory data of the patients were recorded. The demographic data of participants were analyzed to obtain the logistic regression to identify factors associated with the odds ratio. Result: There were One hundred-and-two participants had been screened, and nine of whom was excluded due to the pre-existing delirium. Ninety-three participants with hip fracture were included. The incidence rate of delirium was 54.8%. The average age was 84.5. When postoperative delirium occurred, time to ambulation after surgery was delayed and the average ambulation time per day was decreased. The risk factors were analyzed by logistic regression. Univariate regression suggested age, religion, MMSE (Mini-Mental State Examination), hemoglobin, and hematocrit may be associated to postoperative delirium. Multivariate regression suggested MMSE was a significant risk factor of postoperative delirium in hip fracture. Conclusion: Postoperative delirium has significant impacts on the recovery and long term well-being of elderly patients. Significant predictive risk factors can be parsed out to help practitioners identify patients who are more susceptible to postoperative delirium before they receiving surgery. Recognizing patients who are more likely to develop delirium can also help practitioners develop individualized management to extend postoperative monitoring as needed and mitigate surgical risk factors.
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Cheng, Hsiao-Wei, and 鄭曉薇. "Association between frailty and postoperative delirium in open heart surgery patients." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/75d292.
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"Anticipating Postoperative Delirium During Cardiac Surgeries Involving Deep Hypothermia Circulatory Arrest." Doctoral diss., 2020. http://hdl.handle.net/2286/R.I.57123.
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abstract: Aortic aneurysms and dissections are life threatening conditions addressed by replacing damaged sections of the aorta. Blood circulation must be halted to facilitate repairs. Ischemia places the body, especially the brain, at risk of damage. Deep hypothermia circulatory arrest (DHCA) is employed to protect patients and provide time for surgeons to complete repairs on the basis that reducing body temperature suppresses the metabolic rate. Supplementary surgical techniques can be employed to reinforce the brain's protection and increase the duration circulation can be suspended. Even then, protection is not completely guaranteed though. A medical condition that can arise early in recovery is postoperative delirium, which is correlated with poor long term outcome. This study develops a methodology to intraoperatively monitor neurophysiology through electroencephalography (EEG) and anticipate postoperative delirium. The earliest opportunity to detect occurrences of complications through EEG is immediately following DHCA during warming. The first observable electrophysiological activity after being completely suppressed is a phenomenon known as burst suppression, which is related to the brain's metabolic state and recovery of nominal neurological function. A metric termed burst suppression duty cycle (BSDC) is developed to characterize the changing electrophysiological dynamics. Predictions of postoperative delirium incidences are made by identifying deviations in the way these dynamics evolve. Sixteen cases are examined in this study. Accurate predictions can be made, where on average 89.74% of cases are correctly classified when burst suppression concludes and 78.10% when burst suppression begins. The best case receiver operating characteristic curve has an area under its convex hull of 0.8988, whereas the worst case area under the hull is 0.7889. These results demonstrate the feasibility of monitoring BSDC to anticipate postoperative delirium during burst suppression. They also motivate a further analysis on identifying footprints of causal mechanisms of neural injury within BSDC. Being able to raise warning signs of postoperative delirium early provides an opportunity to intervene and potentially avert neurological complications. Doing so would improve the success rate and quality of life after surgery.Dissertation/Thesis
Doctoral Dissertation Electrical Engineering 2020
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Mao, Xirong, and 毛席容. "Data mining about related factors of Postoperative delirium Morbidity in CABG." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/99624743947696329324.
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碩士國立中央大學
系統生物與生物資訊研究所
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Coronary artery bypass grafting (CABG operation), which is also called coronary artery bypass grafting, referred to as coronary bypass or bypass, is a relief of angina and reduce the risk of death from coronary heart disease operation. The bypass artery or vein were derived from the patient’s own (internal mammary artery, radial artery, right gastroepiploic artery, saphenous vein). The operation bridges the blood vessel on coronary artery to get around the coronary atherosclerotic stenosis, improve coronary perfusion, and increase myocardial oxygen supply. This operation is usually performed in cardiac arrest, requiring the use of cardiopulmonary bypass support; and bypass surgery can also be performed on the beating heart, the so-called “off-pump” operation. Same as other operation, CABG gets risk of coronary artery bypass grafting. For example, the Postoperative delirium, some research shows that delirium is a group of syndrome, also known as acute brain syndrome, the expression is recognizant obstacle, behavior no chapter, no purpose, inability to concentrate. To be strict, delirium is not a disease but clinical syndrome caused by a variety of reasons. In this paper we use MMSE to evaluate the intelligent condition of patients after operation, then analysis the relationships between MMSE and the condition of patients themselves or the ICU.
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Schust, Sabine [Verfasser]. "Das postoperative Delirium : Vergleich der Nursing Delirium Screening Scale und der Confusion Assessment Method im Screening auf der peripheren chirurgischen Station / von Sabine Schust." 2011. http://d-nb.info/1012826341/34.
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Hamann, Johannes [Verfasser]. "Postoperative Delirien und postoperative kognitive Defizite nach urologischen Eingriffen / Johannes Hamann." 2001. http://d-nb.info/963847120/34.
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